|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
$664.60
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
z33229
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$579.02 |
| Rate for Payer: Aetna Medicare |
$340.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$391.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$374.66
|
| Rate for Payer: Cash Price |
$412.05
|
| Rate for Payer: Cash Price |
$412.05
|
| Rate for Payer: Coventry All Commercial |
$408.72
|
| Rate for Payer: Frontpath All Commercial |
$490.23
|
| Rate for Payer: Humana ChoiceCare |
$448.96
|
| Rate for Payer: Humana Medicare |
$340.60
|
| Rate for Payer: Lucent All Commercial |
$579.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.00
|
| Rate for Payer: PHCS All Commercial |
$498.45
|
| Rate for Payer: PHP All Commercial |
$465.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$340.60
|
| Rate for Payer: Signature Care EPO |
$438.63
|
| Rate for Payer: Signature Care PPO |
$438.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.00
|
| Rate for Payer: United Healthcare Commercial |
$454.03
|
| Rate for Payer: United Healthcare Medicare |
$340.60
|
|
|
PR REMV NASAL FOR BODY,GEN ANESTH
|
Professional
|
$383.54
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
z30310
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$334.15 |
| Rate for Payer: Aetna Medicare |
$196.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$226.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$216.22
|
| Rate for Payer: Cash Price |
$237.79
|
| Rate for Payer: Cash Price |
$237.79
|
| Rate for Payer: Coventry All Commercial |
$235.87
|
| Rate for Payer: Frontpath All Commercial |
$267.68
|
| Rate for Payer: Humana ChoiceCare |
$223.21
|
| Rate for Payer: Humana Medicare |
$196.56
|
| Rate for Payer: Lucent All Commercial |
$334.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.00
|
| Rate for Payer: PHCS All Commercial |
$287.66
|
| Rate for Payer: PHP All Commercial |
$268.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.56
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$295.00
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Medicare |
$196.56
|
|
|
PR REMV PILONIDAL LESION COMPLIC
|
Professional
|
$1,398.54
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
z11772
|
| Min. Negotiated Rate |
$453.27 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Aetna Medicare |
$534.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$615.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$588.41
|
| Rate for Payer: Cash Price |
$867.09
|
| Rate for Payer: Cash Price |
$867.09
|
| Rate for Payer: Coventry All Commercial |
$641.90
|
| Rate for Payer: Frontpath All Commercial |
$754.43
|
| Rate for Payer: Humana ChoiceCare |
$453.27
|
| Rate for Payer: Humana Medicare |
$534.92
|
| Rate for Payer: Lucent All Commercial |
$909.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.00
|
| Rate for Payer: PHCS All Commercial |
$1,048.90
|
| Rate for Payer: PHP All Commercial |
$730.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$534.92
|
| Rate for Payer: Signature Care EPO |
$619.99
|
| Rate for Payer: Signature Care PPO |
$619.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$642.00
|
| Rate for Payer: United Healthcare Commercial |
$575.54
|
| Rate for Payer: United Healthcare Medicare |
$534.92
|
|
|
PR REMV PILONIDAL LESION EXTENS
|
Professional
|
$1,136.94
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
z11771
|
| Min. Negotiated Rate |
$343.37 |
| Max. Negotiated Rate |
$852.70 |
| Rate for Payer: Aetna Medicare |
$414.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$533.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.53
|
| Rate for Payer: Cash Price |
$704.90
|
| Rate for Payer: Cash Price |
$704.90
|
| Rate for Payer: Coventry All Commercial |
$496.94
|
| Rate for Payer: Frontpath All Commercial |
$585.62
|
| Rate for Payer: Humana ChoiceCare |
$343.37
|
| Rate for Payer: Humana Medicare |
$414.12
|
| Rate for Payer: Lucent All Commercial |
$704.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.00
|
| Rate for Payer: PHCS All Commercial |
$852.70
|
| Rate for Payer: PHP All Commercial |
$565.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$414.12
|
| Rate for Payer: Signature Care EPO |
$503.53
|
| Rate for Payer: Signature Care PPO |
$503.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$497.00
|
| Rate for Payer: United Healthcare Commercial |
$441.89
|
| Rate for Payer: United Healthcare Medicare |
$414.12
|
|
|
PR REMV PILONIDAL LESION SIMPLE
|
Professional
|
$644.38
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
z11770
|
| Min. Negotiated Rate |
$155.87 |
| Max. Negotiated Rate |
$483.28 |
| Rate for Payer: Aetna Medicare |
$170.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.70
|
| Rate for Payer: Cash Price |
$399.52
|
| Rate for Payer: Cash Price |
$399.52
|
| Rate for Payer: Coventry All Commercial |
$204.77
|
| Rate for Payer: Frontpath All Commercial |
$242.44
|
| Rate for Payer: Humana ChoiceCare |
$155.87
|
| Rate for Payer: Humana Medicare |
$170.64
|
| Rate for Payer: Lucent All Commercial |
$290.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.00
|
| Rate for Payer: PHCS All Commercial |
$483.28
|
| Rate for Payer: PHP All Commercial |
$233.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.64
|
| Rate for Payer: Signature Care EPO |
$289.24
|
| Rate for Payer: Signature Care PPO |
$289.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$205.00
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
| Rate for Payer: United Healthcare Medicare |
$170.64
|
|
|
PR REMV TALUS/HEEL BENIGN BONE LESN
|
Professional
|
$1,113.94
|
|
|
Service Code
|
CPT 28100
|
| Hospital Charge Code |
z28100
|
| Min. Negotiated Rate |
$392.15 |
| Max. Negotiated Rate |
$835.46 |
| Rate for Payer: Aetna Medicare |
$392.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$450.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$431.36
|
| Rate for Payer: Cash Price |
$690.64
|
| Rate for Payer: Cash Price |
$690.64
|
| Rate for Payer: Coventry All Commercial |
$470.58
|
| Rate for Payer: Frontpath All Commercial |
$539.47
|
| Rate for Payer: Humana ChoiceCare |
$448.19
|
| Rate for Payer: Humana Medicare |
$392.15
|
| Rate for Payer: Lucent All Commercial |
$666.66
|
| Rate for Payer: PHCS All Commercial |
$835.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$392.15
|
| Rate for Payer: United Healthcare Commercial |
$454.68
|
| Rate for Payer: United Healthcare Medicare |
$392.15
|
|
|
PR REMV TARSAL/METATARSAL BENIGN BONE LESN
|
Professional
|
$953.04
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
z28104
|
| Min. Negotiated Rate |
$332.53 |
| Max. Negotiated Rate |
$714.78 |
| Rate for Payer: Aetna Medicare |
$332.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$382.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.78
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Coventry All Commercial |
$399.04
|
| Rate for Payer: Frontpath All Commercial |
$451.83
|
| Rate for Payer: Humana ChoiceCare |
$391.86
|
| Rate for Payer: Humana Medicare |
$332.53
|
| Rate for Payer: Lucent All Commercial |
$565.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.00
|
| Rate for Payer: PHCS All Commercial |
$714.78
|
| Rate for Payer: PHP All Commercial |
$564.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$332.53
|
| Rate for Payer: Signature Care EPO |
$658.75
|
| Rate for Payer: Signature Care PPO |
$658.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$499.00
|
| Rate for Payer: United Healthcare Commercial |
$398.49
|
| Rate for Payer: United Healthcare Medicare |
$332.53
|
|
|
PR REOPEN FALLOPIAN TUBE,CHROMOTUBATION
|
Professional
|
$282.36
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
z58350
|
| Min. Negotiated Rate |
$84.06 |
| Max. Negotiated Rate |
$211.77 |
| Rate for Payer: Aetna Medicare |
$89.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.40
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Cash Price |
$175.06
|
| Rate for Payer: Coventry All Commercial |
$107.34
|
| Rate for Payer: Frontpath All Commercial |
$123.08
|
| Rate for Payer: Humana ChoiceCare |
$84.06
|
| Rate for Payer: Humana Medicare |
$89.45
|
| Rate for Payer: Lucent All Commercial |
$152.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: PHCS All Commercial |
$211.77
|
| Rate for Payer: PHP All Commercial |
$115.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.45
|
| Rate for Payer: Signature Care EPO |
$124.98
|
| Rate for Payer: Signature Care PPO |
$124.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$86.93
|
| Rate for Payer: United Healthcare Medicare |
$89.45
|
|
|
PR REOPEN RECENT ABD EXPLORATORY
|
Professional
|
$1,856.84
|
|
|
Service Code
|
CPT 49002
|
| Hospital Charge Code |
z49002
|
| Min. Negotiated Rate |
$708.37 |
| Max. Negotiated Rate |
$1,624.73 |
| Rate for Payer: Aetna Medicare |
$951.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$835.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$835.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,094.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,046.79
|
| Rate for Payer: Cash Price |
$1,151.24
|
| Rate for Payer: Cash Price |
$1,151.24
|
| Rate for Payer: Coventry All Commercial |
$1,141.96
|
| Rate for Payer: Frontpath All Commercial |
$1,378.64
|
| Rate for Payer: Humana ChoiceCare |
$708.37
|
| Rate for Payer: Humana Medicare |
$951.63
|
| Rate for Payer: Lucent All Commercial |
$1,617.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,427.00
|
| Rate for Payer: PHCS All Commercial |
$1,392.63
|
| Rate for Payer: PHP All Commercial |
$1,624.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$951.63
|
| Rate for Payer: Signature Care EPO |
$898.45
|
| Rate for Payer: Signature Care PPO |
$898.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,332.00
|
| Rate for Payer: United Healthcare Commercial |
$1,087.29
|
| Rate for Payer: United Healthcare Medicare |
$951.63
|
|
|
PR REPAIR 1 COLLAT ANKLE LIGMNT,PRIMARY
|
Professional
|
$887.66
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
z27695
|
| Min. Negotiated Rate |
$454.93 |
| Max. Negotiated Rate |
$773.38 |
| Rate for Payer: Aetna Medicare |
$454.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$523.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$500.42
|
| Rate for Payer: Cash Price |
$550.35
|
| Rate for Payer: Cash Price |
$550.35
|
| Rate for Payer: Coventry All Commercial |
$545.92
|
| Rate for Payer: Frontpath All Commercial |
$618.85
|
| Rate for Payer: Humana ChoiceCare |
$536.74
|
| Rate for Payer: Humana Medicare |
$454.93
|
| Rate for Payer: Lucent All Commercial |
$773.38
|
| Rate for Payer: PHCS All Commercial |
$665.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$454.93
|
| Rate for Payer: United Healthcare Commercial |
$537.73
|
| Rate for Payer: United Healthcare Medicare |
$454.93
|
|
|
PR REPAIR ACHILLES TENDON,PRIMARY
|
Professional
|
$1,205.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
z27650
|
| Min. Negotiated Rate |
$617.56 |
| Max. Negotiated Rate |
$1,049.85 |
| Rate for Payer: Aetna Medicare |
$617.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$926.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$926.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$710.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$679.32
|
| Rate for Payer: Cash Price |
$747.10
|
| Rate for Payer: Cash Price |
$747.10
|
| Rate for Payer: Coventry All Commercial |
$741.07
|
| Rate for Payer: Frontpath All Commercial |
$850.77
|
| Rate for Payer: Humana ChoiceCare |
$750.71
|
| Rate for Payer: Humana Medicare |
$617.56
|
| Rate for Payer: Lucent All Commercial |
$1,049.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$988.00
|
| Rate for Payer: PHCS All Commercial |
$903.75
|
| Rate for Payer: PHP All Commercial |
$1,048.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$617.56
|
| Rate for Payer: Signature Care EPO |
$1,008.10
|
| Rate for Payer: Signature Care PPO |
$1,008.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$926.00
|
| Rate for Payer: United Healthcare Commercial |
$734.25
|
| Rate for Payer: United Healthcare Medicare |
$617.56
|
|
|
PR REPAIR BICEPS LONG TENDON
|
Professional
|
$1,354.46
|
|
|
Service Code
|
CPT 23430
|
| Hospital Charge Code |
z23430
|
| Min. Negotiated Rate |
$694.16 |
| Max. Negotiated Rate |
$1,180.07 |
| Rate for Payer: Aetna Medicare |
$694.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$942.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$942.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$798.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$763.58
|
| Rate for Payer: Cash Price |
$839.77
|
| Rate for Payer: Cash Price |
$839.77
|
| Rate for Payer: Coventry All Commercial |
$832.99
|
| Rate for Payer: Frontpath All Commercial |
$966.37
|
| Rate for Payer: Humana ChoiceCare |
$789.37
|
| Rate for Payer: Humana Medicare |
$694.16
|
| Rate for Payer: Lucent All Commercial |
$1,180.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,111.00
|
| Rate for Payer: PHCS All Commercial |
$1,015.84
|
| Rate for Payer: PHP All Commercial |
$1,178.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$694.16
|
| Rate for Payer: Signature Care EPO |
$1,058.25
|
| Rate for Payer: Signature Care PPO |
$1,058.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,041.00
|
| Rate for Payer: United Healthcare Commercial |
$800.95
|
| Rate for Payer: United Healthcare Medicare |
$694.16
|
|
|
PR REPAIR BLEED LIVER/SUTURE WOUND
|
Professional
|
$2,438.12
|
|
|
Service Code
|
CPT 47350
|
| Hospital Charge Code |
z47350
|
| Min. Negotiated Rate |
$1,004.60 |
| Max. Negotiated Rate |
$2,133.36 |
| Rate for Payer: Aetna Medicare |
$1,249.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,004.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,004.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,436.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,374.49
|
| Rate for Payer: Cash Price |
$1,511.63
|
| Rate for Payer: Cash Price |
$1,511.63
|
| Rate for Payer: Coventry All Commercial |
$1,499.45
|
| Rate for Payer: Frontpath All Commercial |
$1,807.66
|
| Rate for Payer: Humana ChoiceCare |
$1,302.35
|
| Rate for Payer: Humana Medicare |
$1,249.54
|
| Rate for Payer: Lucent All Commercial |
$2,124.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,874.00
|
| Rate for Payer: PHCS All Commercial |
$1,828.59
|
| Rate for Payer: PHP All Commercial |
$2,133.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,249.54
|
| Rate for Payer: Signature Care EPO |
$1,625.20
|
| Rate for Payer: Signature Care PPO |
$1,625.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,749.00
|
| Rate for Payer: United Healthcare Commercial |
$1,456.69
|
| Rate for Payer: United Healthcare Medicare |
$1,249.54
|
|
|
PR REPAIR COLLAT LIGAMT/CAPSULE,KNEE
|
Professional
|
$1,230.94
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
z27405
|
| Min. Negotiated Rate |
$630.86 |
| Max. Negotiated Rate |
$1,072.46 |
| Rate for Payer: Aetna Medicare |
$630.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$725.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$693.95
|
| Rate for Payer: Cash Price |
$763.18
|
| Rate for Payer: Cash Price |
$763.18
|
| Rate for Payer: Coventry All Commercial |
$757.03
|
| Rate for Payer: Frontpath All Commercial |
$879.32
|
| Rate for Payer: Humana ChoiceCare |
$703.00
|
| Rate for Payer: Humana Medicare |
$630.86
|
| Rate for Payer: Lucent All Commercial |
$1,072.46
|
| Rate for Payer: PHCS All Commercial |
$923.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$630.86
|
| Rate for Payer: United Healthcare Commercial |
$727.81
|
| Rate for Payer: United Healthcare Medicare |
$630.86
|
|
|
PR REPAIR EXTEN LEG TENDON,PRIM,EA
|
Professional
|
$885.32
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
z28208
|
| Min. Negotiated Rate |
$303.07 |
| Max. Negotiated Rate |
$663.99 |
| Rate for Payer: Aetna Medicare |
$303.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$427.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$427.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$348.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$333.38
|
| Rate for Payer: Cash Price |
$548.90
|
| Rate for Payer: Cash Price |
$548.90
|
| Rate for Payer: Coventry All Commercial |
$363.68
|
| Rate for Payer: Frontpath All Commercial |
$408.72
|
| Rate for Payer: Humana ChoiceCare |
$332.32
|
| Rate for Payer: Humana Medicare |
$303.07
|
| Rate for Payer: Lucent All Commercial |
$515.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.00
|
| Rate for Payer: PHCS All Commercial |
$663.99
|
| Rate for Payer: PHP All Commercial |
$514.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.07
|
| Rate for Payer: Signature Care EPO |
$578.85
|
| Rate for Payer: Signature Care PPO |
$578.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$455.00
|
| Rate for Payer: United Healthcare Commercial |
$347.36
|
| Rate for Payer: United Healthcare Medicare |
$303.07
|
|
|
PR REPAIR EXTEN TENDON,DISTAL INSERT,OPEN
|
Professional
|
$1,055.82
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
z26433
|
| Min. Negotiated Rate |
$541.11 |
| Max. Negotiated Rate |
$919.89 |
| Rate for Payer: Aetna Medicare |
$541.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$589.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$589.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$622.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$595.22
|
| Rate for Payer: Cash Price |
$654.61
|
| Rate for Payer: Cash Price |
$654.61
|
| Rate for Payer: Coventry All Commercial |
$649.33
|
| Rate for Payer: Frontpath All Commercial |
$740.74
|
| Rate for Payer: Humana ChoiceCare |
$640.33
|
| Rate for Payer: Humana Medicare |
$541.11
|
| Rate for Payer: Lucent All Commercial |
$919.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.00
|
| Rate for Payer: PHCS All Commercial |
$791.86
|
| Rate for Payer: PHP All Commercial |
$918.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$541.11
|
| Rate for Payer: Signature Care EPO |
$842.47
|
| Rate for Payer: Signature Care PPO |
$842.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$812.00
|
| Rate for Payer: United Healthcare Commercial |
$555.48
|
| Rate for Payer: United Healthcare Medicare |
$541.11
|
|
|
PR REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Professional
|
$1,150.18
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
z26418
|
| Min. Negotiated Rate |
$589.46 |
| Max. Negotiated Rate |
$1,002.08 |
| Rate for Payer: Aetna Medicare |
$589.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$767.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$767.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$677.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$648.41
|
| Rate for Payer: Cash Price |
$713.11
|
| Rate for Payer: Cash Price |
$713.11
|
| Rate for Payer: Coventry All Commercial |
$707.35
|
| Rate for Payer: Frontpath All Commercial |
$803.60
|
| Rate for Payer: Humana ChoiceCare |
$686.75
|
| Rate for Payer: Humana Medicare |
$589.46
|
| Rate for Payer: Lucent All Commercial |
$1,002.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$943.00
|
| Rate for Payer: PHCS All Commercial |
$862.64
|
| Rate for Payer: PHP All Commercial |
$1,000.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$589.46
|
| Rate for Payer: Signature Care EPO |
$914.14
|
| Rate for Payer: Signature Care PPO |
$914.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$884.00
|
| Rate for Payer: United Healthcare Commercial |
$592.40
|
| Rate for Payer: United Healthcare Medicare |
$589.46
|
|
|
PR REPAIR EXTEN TENDON,DORSUM HAND,EA
|
Professional
|
$1,108.36
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
z26410
|
| Min. Negotiated Rate |
$568.03 |
| Max. Negotiated Rate |
$965.65 |
| Rate for Payer: Aetna Medicare |
$568.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$931.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$931.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$653.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$624.83
|
| Rate for Payer: Cash Price |
$687.18
|
| Rate for Payer: Cash Price |
$687.18
|
| Rate for Payer: Coventry All Commercial |
$681.64
|
| Rate for Payer: Frontpath All Commercial |
$777.66
|
| Rate for Payer: Humana ChoiceCare |
$689.06
|
| Rate for Payer: Humana Medicare |
$568.03
|
| Rate for Payer: Lucent All Commercial |
$965.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$909.00
|
| Rate for Payer: PHCS All Commercial |
$831.27
|
| Rate for Payer: PHP All Commercial |
$964.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$568.03
|
| Rate for Payer: Signature Care EPO |
$894.32
|
| Rate for Payer: Signature Care PPO |
$894.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$852.00
|
| Rate for Payer: United Healthcare Commercial |
$591.18
|
| Rate for Payer: United Healthcare Medicare |
$568.03
|
|
|
PR REPAIR FLEX FOOT TENDON,EA
|
Professional
|
$899.62
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
z28200
|
| Min. Negotiated Rate |
$307.93 |
| Max. Negotiated Rate |
$674.72 |
| Rate for Payer: Aetna Medicare |
$307.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$449.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.72
|
| Rate for Payer: Cash Price |
$557.76
|
| Rate for Payer: Cash Price |
$557.76
|
| Rate for Payer: Coventry All Commercial |
$369.52
|
| Rate for Payer: Frontpath All Commercial |
$419.47
|
| Rate for Payer: Humana ChoiceCare |
$352.81
|
| Rate for Payer: Humana Medicare |
$307.93
|
| Rate for Payer: Lucent All Commercial |
$523.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$493.00
|
| Rate for Payer: PHCS All Commercial |
$674.72
|
| Rate for Payer: PHP All Commercial |
$522.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$307.93
|
| Rate for Payer: Signature Care EPO |
$603.50
|
| Rate for Payer: Signature Care PPO |
$603.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$361.86
|
| Rate for Payer: United Healthcare Medicare |
$307.93
|
|
|
PR REPAIR FLEX LEG TENDON,PRIM,EA
|
Professional
|
$678.32
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
z27658
|
| Min. Negotiated Rate |
$347.64 |
| Max. Negotiated Rate |
$590.99 |
| Rate for Payer: Aetna Medicare |
$347.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$399.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.40
|
| Rate for Payer: Cash Price |
$420.56
|
| Rate for Payer: Cash Price |
$420.56
|
| Rate for Payer: Coventry All Commercial |
$417.17
|
| Rate for Payer: Frontpath All Commercial |
$474.93
|
| Rate for Payer: Humana ChoiceCare |
$412.78
|
| Rate for Payer: Humana Medicare |
$347.64
|
| Rate for Payer: Lucent All Commercial |
$590.99
|
| Rate for Payer: PHCS All Commercial |
$508.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$347.64
|
| Rate for Payer: United Healthcare Commercial |
$416.14
|
| Rate for Payer: United Healthcare Medicare |
$347.64
|
|
|
PR REPAIR FLEX TENDON,ZONE 2,HAND
|
Professional
|
$1,455.70
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
z26356
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,268.28 |
| Rate for Payer: Aetna Medicare |
$746.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,168.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,168.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$857.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$820.66
|
| Rate for Payer: Cash Price |
$902.53
|
| Rate for Payer: Cash Price |
$902.53
|
| Rate for Payer: Coventry All Commercial |
$895.26
|
| Rate for Payer: Frontpath All Commercial |
$1,024.96
|
| Rate for Payer: Humana ChoiceCare |
$1,103.50
|
| Rate for Payer: Humana Medicare |
$746.05
|
| Rate for Payer: Lucent All Commercial |
$1,268.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.00
|
| Rate for Payer: PHCS All Commercial |
$1,091.78
|
| Rate for Payer: PHP All Commercial |
$1,266.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$746.05
|
| Rate for Payer: Signature Care EPO |
$1,265.02
|
| Rate for Payer: Signature Care PPO |
$1,265.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,119.00
|
| Rate for Payer: United Healthcare Commercial |
$1,109.68
|
| Rate for Payer: United Healthcare Medicare |
$746.05
|
|
|
PR REPAIR/GRAFT ACHILLES TENDON
|
Professional
|
$1,220.76
|
|
|
Service Code
|
CPT 27652
|
| Hospital Charge Code |
z27652
|
| Min. Negotiated Rate |
$625.64 |
| Max. Negotiated Rate |
$1,063.59 |
| Rate for Payer: Aetna Medicare |
$625.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$996.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$996.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$719.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$688.20
|
| Rate for Payer: Cash Price |
$756.87
|
| Rate for Payer: Cash Price |
$756.87
|
| Rate for Payer: Coventry All Commercial |
$750.77
|
| Rate for Payer: Frontpath All Commercial |
$854.14
|
| Rate for Payer: Humana ChoiceCare |
$801.08
|
| Rate for Payer: Humana Medicare |
$625.64
|
| Rate for Payer: Lucent All Commercial |
$1,063.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,001.00
|
| Rate for Payer: PHCS All Commercial |
$915.57
|
| Rate for Payer: PHP All Commercial |
$1,062.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$625.64
|
| Rate for Payer: Signature Care EPO |
$1,063.16
|
| Rate for Payer: Signature Care PPO |
$1,063.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$811.29
|
| Rate for Payer: United Healthcare Medicare |
$625.64
|
|
|
PR REPAIR ING HERNIA,5+Y/O,STRANG
|
Professional
|
$1,052.70
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
z49507
|
| Min. Negotiated Rate |
$539.51 |
| Max. Negotiated Rate |
$921.11 |
| Rate for Payer: Aetna Medicare |
$539.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$677.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$677.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$620.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$593.46
|
| Rate for Payer: Cash Price |
$652.67
|
| Rate for Payer: Cash Price |
$652.67
|
| Rate for Payer: Coventry All Commercial |
$647.41
|
| Rate for Payer: Frontpath All Commercial |
$775.81
|
| Rate for Payer: Humana ChoiceCare |
$642.09
|
| Rate for Payer: Humana Medicare |
$539.51
|
| Rate for Payer: Lucent All Commercial |
$917.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$809.00
|
| Rate for Payer: PHCS All Commercial |
$789.52
|
| Rate for Payer: PHP All Commercial |
$921.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$539.51
|
| Rate for Payer: Signature Care EPO |
$811.75
|
| Rate for Payer: Signature Care PPO |
$811.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$755.00
|
| Rate for Payer: United Healthcare Commercial |
$672.50
|
| Rate for Payer: United Healthcare Medicare |
$539.51
|
|
|
PR REPAIR INTERCARP/CARP-METACARP JT
|
Professional
|
$1,517.22
|
|
|
Service Code
|
CPT 25447
|
| Hospital Charge Code |
z25447
|
| Min. Negotiated Rate |
$777.57 |
| Max. Negotiated Rate |
$1,321.87 |
| Rate for Payer: Aetna Medicare |
$777.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,014.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,014.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$894.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$855.33
|
| Rate for Payer: Cash Price |
$940.68
|
| Rate for Payer: Cash Price |
$940.68
|
| Rate for Payer: Coventry All Commercial |
$933.08
|
| Rate for Payer: Frontpath All Commercial |
$1,074.09
|
| Rate for Payer: Humana ChoiceCare |
$825.83
|
| Rate for Payer: Humana Medicare |
$777.57
|
| Rate for Payer: Lucent All Commercial |
$1,321.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,244.00
|
| Rate for Payer: PHCS All Commercial |
$1,137.92
|
| Rate for Payer: PHP All Commercial |
$1,319.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$777.57
|
| Rate for Payer: Signature Care EPO |
$1,101.60
|
| Rate for Payer: Signature Care PPO |
$1,101.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,166.00
|
| Rate for Payer: United Healthcare Commercial |
$878.58
|
| Rate for Payer: United Healthcare Medicare |
$777.57
|
|
|
PR REPAIR NON/MALUNION METATARSAL
|
Professional
|
$1,431.86
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
z28322
|
| Min. Negotiated Rate |
$542.12 |
| Max. Negotiated Rate |
$1,073.90 |
| Rate for Payer: Aetna Medicare |
$542.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$711.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$711.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$623.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$596.33
|
| Rate for Payer: Cash Price |
$887.75
|
| Rate for Payer: Cash Price |
$887.75
|
| Rate for Payer: Coventry All Commercial |
$650.54
|
| Rate for Payer: Frontpath All Commercial |
$743.80
|
| Rate for Payer: Humana ChoiceCare |
$639.01
|
| Rate for Payer: Humana Medicare |
$542.12
|
| Rate for Payer: Lucent All Commercial |
$921.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.00
|
| Rate for Payer: PHCS All Commercial |
$1,073.90
|
| Rate for Payer: PHP All Commercial |
$920.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$542.12
|
| Rate for Payer: Signature Care EPO |
$1,064.20
|
| Rate for Payer: Signature Care PPO |
$1,064.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$813.00
|
| Rate for Payer: United Healthcare Commercial |
$645.21
|
| Rate for Payer: United Healthcare Medicare |
$542.12
|
|
